Strategies to balance stroke and bleeding risk in patients with atrial fibrillation and cancer

A 76-year-old female with obesity, hypertension, persistent atrial fibrillation, and heart failure with preserved ejection fraction is started on ibrutinib 420 mg once daily for Waldenstrom ’s macroglobulinemia. Due to concern for drug-drug interactions, her amiodarone is decreased from 200 to 100 mg daily, and she is continued on metoprolol succinate 100 mg daily and apixaban 5 mg twice daily. She presents to the clinic one month later with extensive superficial ecchymoses, and her apixaban dose is reduced to 2.5 mg twice daily due to concerns that this may reflect the combined antiplatelet effects of ibrutinib and anticoagulant effects of apixaban.
Source: Heart Rhythm - Category: Cardiology Authors: Source Type: research